Are most maternal deaths from pre-eclampsia avoidable?

摘要

In the latest UK Report of the Confidential Enquiries into Maternal Deaths (the CMACE report),1 20 out of 22 deaths related to pre-eclampsia involved substandard care—a disturbing statistic that is higher than for any other cause of maternal death. The substandard care in 63% of these deaths was categorised as major and they were described as "undoubtedly avoidable". Hypertensive diseases accounted for 17-8% of all direct maternal deaths, an increase in frequency since the last triennial report, while overall death rates have reduced.Pre-eclampsia complicates 2-8% of pregnancies,2 although the proportion is probably less than 5% in western nations,3 representing up to 30000 women a year in the UK. Although maternal deaths are relatively rare, pre-eclampsia causes a third of severe obstetric morbidity.4 Fetal morbidity and mortality increase substantially in women with pre-eclampsia;5 hypertension is a major cause of stillbirths, as recently highlighted in The Lancet.5 However, fetal compromise can be identified and adverse events can be prevented by delivery.